The midwife is the lead professional in low-risk maternity care and the coordinator of care in complex cases where a multi-professional approach is required (Power, 2016). Caesarean sections now account for more than a quarter of all births in England—166 081 (26.2%) births in 2013–14 (Health and Social Care Information Centre (HSCIC), 2015). In 2013–14, epidural or caudal anaesthesia was required in 16.4% (86 673) of births, mainly for instrumental births, while spinal anaesthetics were used in 15.1% (79 975) of births, mostly for caesarean sections (HSCIC, 2015). Support from obstetric anaesthesia services (OAS) is also required in obstetric emergencies, such as postpartum haemorrhage, which occurred in 13.8% of births in 2013–14, and eclampsia, which affects about 1/4000 pregnancies. Given the high rate of caesarean sections and the input of OAS in pain management in labour and the management of obstetric emergencies, educators at the University of Northampton have decided that it is good practice to provide student midwives with an opportunity to learn about the role of OAS—and, more specifically, the consultant anaesthetist—in the safe environment of the classroom.
The consultant anaesthetist: Dr Kalpna Gupta
I became a doctor by choice. Early in my career I became interested in obstetric anaesthesia. I worked at a maternity and children's hospital abroad for 5 years. In my current place of work, I was offered an opportunity to be the lead clinician for obstetric anaesthesia services, and held this role for about 6 years. During my time at the Trust, the labour ward has undergone a lot of expansion and now has two dedicated theatres for obstetrics, along with facilities to provide high-risk obstetric care on the labour ward if required. The Trust has approximately 5000 births per year and there is a dedicated epidural service for mothers requesting pain relief.
I currently cover the labour ward for 1 day per week, and I have witnessed changes in service provision over the last 10 years as the service has evolved to meet the changing expectations of the women who use it. In terms of multi-professional working and training, we have regular multi-professional training sessions for midwives, medical students and doctors using a state-of-the-art simulator to manage emergencies such as antepartum haemorrhage, cord prolapse and shoulder dystocia.
Why teach?
I first became interested in teaching when I was at school. I would watch my teachers with awe when they made a difficult problem look easy. They seemed to know everything. This fascination with the sharing of knowledge stayed with me throughout my training to become a doctor specialising in anaesthetics. I started my journey into midwifery teaching about 4 years ago, and I currently teach the midwifery students in all years of their pre-registration programme. Thetopics given to me are interesting and challenging, which is good for the brain!
‘Students should have an understanding of the basics of anaesthesia to be able to interact appropriately with the multi-professional team’
The sessions
I teach homeostasis, fluid balance and regional analgesia in year 1; general anaesthesia in year 2; and in year 3 we explore the role of the anaesthetist in an obstetric emergency and clotting and disseminated intravascular coagulation. I use PowerPoint presentations, with video clips of procedures such as insertion of an epidural and induction of general anaesthesia, as I believe that visual prompts in lectures capture more attention than simply reading from a text.
Student evaluation
I feel it is very important to get feedback about the sessions I teach, both for my own personal development and to ensure I am providing the students with a valuable learning experience. Feedback has generally been very positive, with recent comments following the session on homeostasis, fluid balance and regional analgesia from first-year students including:
‘Good timing having it just after the renal system exam—good way to consolidate learning.’
‘Interesting presentation with excellent detail that was explained at a relevant level to first-year student midwives.’
‘I liked how Dr Gupta related the slides to clinical situations—easier way to take it all in.’
‘Well presented, Dr Gupta explained fluid balance in simple terms related to clinical practice.’
‘I found the session very informative and I understood what the session was about due to the session being in simple terms.
I also liked how Dr Gupta ensured we understood everything.’
‘I have no suggestions, she was brilliant!’
Some students have made suggestions for how the sessions can be improved, such as:
‘More examples related to midwifery practice would have been more informative for us.’
‘Maybe include some activities for the cohort to help aid our knowledge and consolidate it all at the end of the session with activities.’
‘There was some technical language [which was] difficult to understand, a lot of writing on the slides.’
‘A little bit too much information for midwives, but very interesting.’
I take on board students’ comments regarding the complexity of the information; however, my take on these comments is that students should be prepared for the realities of the service, so they need to have an understanding of what I consider to be the basics of anaesthesia to be able to interact appropriately with the multi-professional team and participate in the care of high-risk women.
Conclusion
Obstetric anaesthesia services are embedded in maternity services, particularly given that caesarean sections accounted for more than a quarter of births in England in 2013–14 (HSCIC, 2015). In addition, current policy states that women should have choice and control with regard to pain management in labour (including epidural anaesthesia), and obstetric emergencies require prompt, professional and appropriate management by a well-drilled multi-professional team. By attending the sessions facilitated by Dr Gupta, student midwives have been given the opportunity to learn from an expert clinician in the classroom setting in preparation for the realities of practice.